Jeffrey Kao

Implementing self-service strategies enables providers to improve interactions with patients, simplify workflow for staff, and optimize revenue while collecting payments quicker.

At a Glance

Adopting self-service check-in processes allows a hospital to simplify the workflow for billing and administrative staff and boost financial performance. Implementing self-service technology:

  • Eliminates need for staff to scan patient data provided on paper registration forms  
  • Facilitates seamless and secure flow of patient data throughout the care process  
  • Creates shorter lines and reduced wait times for patients  
  • Enables providers to collect payments quicker  

Patients now pay more in medical expenses than their employers, according to a recent study.a Between rising insurance premiums, increasing out-of-pocket obligations, and bills resulting from noncovered services, today's consumers shoulder a much larger financial responsibility for care than they did just a few years ago, much of it in the form of higher copayments and deductibles.

Meanwhile, the self-pay population in the United States is growing rapidly, with 83 percent of healthcare organizations reporting an upswing in the number of self-pay patients they currently serve.b  

Together, these two segments of the patient population owe a staggering $250 billion in out-of-pocket medical bills annually, and this number is expected to reach $420 billion by 2015.c  

As a result of these shifting industry dynamics, many providers find themselves in uncharted territory-a place where patient payments comprise nearly 30 percent of an organization's overall income, but traditional approaches to billing and collections no longer apply.d In fact, estimates show that hospitals typically collect only 35 to 65 percent of patient payments on average, accounting for $65 billion in uncollected income in 2010, or approximately 4 to 6 percent of a hospital's gross revenues.

Changing Expectations

For years, the standard process for collecting patient fees has been to bill the remaining balance, including copayments or deductibles, once reimbursement was received from the insurer. Although this traditional approach was more than sufficient when patient payments represented a fraction of overall revenue, it is no longer adequate now that patients bear greater financial responsibility for care. Aside from having a negative impact on cash flow, this method puts providers at serious risk for patient write-offs and bad debt.

With growing patient financial obligations, providers require new revenue cycle management strategies that better reflect the complex demands of today's marketplace. By thinking more like consumers and gaining greater insight into changing preferences across several industries, providers can enhance collections and improve cash flow.

For example, consider a bank deposit or a ticket purchase for an airline flight-these routine interactions are often facilitated by kiosks, ATMs, websites, and mobile phone applications. Today's consumers rely on a variety of self-service tools when dealing with airlines, phone companies, banks, and grocery stores, and they now expect the same level of convenience when managing health-related activities.

According to a 2010 survey conducted by Buzzback Research, 79 percent of respondents said they would be more likely to select a healthcare provider that allows them to manage various healthcare interactions-such as appointment scheduling, registration, and bill payment-over the Internet, on a mobile device, or at a self-service kiosk. More than half surveyed indicated they would like to manage their healthcare account by viewing payment histories and settling outstanding balances via online and mobile channels.

Extending the Benefits of EHRs Through Self-Service

Despite shifting consumer preferences, few providers are technologically equipped to offer the level of self-service convenience that patients now desire. Currently, only one in five adults can schedule medical appointments electronically or email a physician.

But as healthcare organizations continue to make significant technology investments in anticipation of American Recovery and Reinvestment Act incentive payments, providers now have an opportunity to automate and improve routine interactions with patients. Leveraging patient-facing technologies, including portals, personal health records, kiosks, and mobile applications, in combination with electronic health record (EHR) systems will help to facilitate the secure and timely exchange of patient information. Capturing data in an electronic format also helps drive efficiencies, increase revenue collection, and boost patient satisfaction.

Case Study: Empowering Patients

At the Medical Center of Central Georgia (MCCG), a 603-bed regional medical center in Macon, Ga., the adoption of automated self-service check-in processes has eliminated the need for staff to re-enter or scan patient data provided on paper registration forms into the EHR system. Integration between the organization's self-service applications and existing IT systems facilitates a seamless and secure flow of patient data throughout the care process, saving valuable staff time and improving overall efficiency. The kiosk implementation has also resulted in shorter lines and reduced wait times, providing a convenient and pleasant patient experience. In fact, 99 percent of patients have rated the kiosks "easy to flow through."

Patients arriving for appointments at MCCG begin the check-in process by swiping a driver's license or credit card at the kiosk and entering their date of birth and the last four digits of their Social Security numbers. Because many kiosk users have preregistered for their visit, most patients simply validate that the information on file is correct. If patients have not preregistered, they are prompted to enter the required demographic and insurance information before signing consent forms, privacy notices, and precertification authorizations. Finally, patients are asked to remit any copayments and outstanding balances by swiping a credit card on the kiosk.

Aside from automating and expediting the registration process, MCCG's self-service strategy also helps the medical center manage staffing challenges. With 29 different points of patient registration, MCCG faced staffing shortages on a daily basis and struggled to find employees to staff expanded services. But when the medical center moved its heart services to a new building, the kiosks significantly reduced staffing needs, and MCCG was able to avoid costs equivalent to hiring four or five new FTEs.

At each step of the implementation process, MCCG has focused its self-service resources on high-volume areas where technology can potentially yield the greatest staff savings. Later this year, the medical center plans to expand kiosk usage to additional areas, including the emergency department and urgent care department. As more providers adopt self-service, the cumulative impact on staff productivity will be quite significant.

A Multichannel Approach

Beyond improvements to staff productivity and information exchange, patient-facing technologies also enable providers to better connect with patients at every step of the care process, creating a more personalized and meaningful patient experience. If deployed across multiple channels, including the web, mobile devices, and at the healthcare facility, the technologies further empower patients. They have greater control over their information when scheduling appointments online, checking in at a kiosk, or reviewing payment histories on a mobile device.

Case Study: Engaging Patients

When Winter Park, Fla.-based Adventist Health System (AHS) embarked on a self-service initiative, a core objective was allowing patients to manage a variety of health-related transactions at their convenience. By providing access to medical information, both clinical and financial, in an expedient and efficient manner, AHS sought to support the industrywide movement to better engage patients in the healthcare process.

The health system's multiphase deployment began with a patient portal, which operates like a virtual "front door" to the health system's43 campuses. Through the portal, patients schedule appointments, preregister for visits, and pay bills. AHS then deployed self-service kiosks at facilities to help streamline the registration process, minimize wait times, and reduce the purchase, printing, and filing costs associated with paper-based forms. By engaging patients to enter and verify their own demographic and insurance data, AHS sought to improve data accuracy and ultimately helped reduce claim denials and time-consuming rework.

By offering a combination of convenient payment options, streamlined registration at the point of service, and online access to appointment scheduling and preregistration, AHS improved satisfaction rates and loyalty among patients. Self-service kiosks also shortened registration times by four minutes per visit, increased patient throughput, and cut wait times.

In 2010, AHS expanded self-service by allowing patients to enroll in flexible payment plans for outstanding balances both online and at the point of service. This capability streamlines billing workflow for staff and enhances patient convenience. Patients no longer have to deal with the hassle of returning a check and coupon or making phone payments. Establishing payment arrangements that fit each individual's budget also increases the likelihood that AHS will eventually capture outstanding patient balances, while minimizing the potential for bad debt.

Since rolling out the recurring payment plan feature, AHS has increased collections by $150,000 per month, while saving six to 10 cents on every dollar that avoids placement with an early-out agency. Equally important, this capability lets the health system take a "lights out" approach where patients set up a payment plan and no longer think about it. Once staff verifies the required information and creates a schedule, payments arrive regularly without any additional work.

With 250 patients monthly, on average, using recurring payment plans, transaction costs have decreased by 20 to 25 cents per transaction, or about $3,000 to $4,000 per month. The higher volume of credit card payments also has allowed AHS to negotiate better rates with a merchant services provider.

Through the combined implementation of the online patient portal, registration kiosks, and recurring payment plans, AHS has captured more than $11 million in revenue via self-service channels. The health system has reduced overall billing and collections costs by 10 percent. In addition, AHS now has the ability to clearly establish patient expectations regarding their out-of-pocket fees at various stages of care, which is imperative as individuals face higher financial obligations for medical services.

Looking Ahead

With patient financial responsibility continuing to grow at an astounding rate and bad debt on the rise, it is critical that healthcare providers examine existing revenue cycle management processes and implement strategies geared toward maximizing patient collections, driving efficiencies, and maintaining profitability.

When deployed alongside retail-based payment strategies such as online bill payment, time-of-service collections, and recurring payment plans, self-service technologies provide a proven, innovative vehicle for optimizing revenue and increasing financial performance. Beyond being patient friendly, self-service dramatically simplifies workflow for billing and administrative staff, while giving healthcare providers the ability to collect payments more quickly. In addition, kiosks, patient portals, and mobile applications empower patients to be more engaged in the care process, resulting in increased satisfaction and loyalty.

Jeffrey Kao is vice president and general manager, healthcare, NCR Corp., Duluth, Ga. (


a. "The Next Wave of Change for U.S. Health Care Payments," McKinsey Quarterly, May 2010.

b. "Latest Recession Negatively Impacting Healthcare Organization Balance Sheets More Than 2001 Economic Recession," TransUnion press release, April 13, 2010.

c. "Overhauling the U.S. Health Care Payment System," McKinsey Quarterly, June 2007.

d. "The 'Retailish' Future of Patient Collections," Celent press release, Feb. 17, 2009.


Publication Date: Thursday, September 01, 2011

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